Prognostic significance of pre- and post-operative tumour markers for patients with gastric cancer

• Published in: British journal of cancer Vol. 123; no. 3; pp. 418 - 425
• Main Authors: Lin, Jun-Peng, Lin, Jian-Xian, Ma, Yu-Bin, Xie, Jian-Wei, Yan, Su, Wang, Jia-Bin, Lu, Jun, Chen, Qi-Yue, Ma, Xin-Fu, Cao, Long-Long, Lin, Mi, Tu, Ru-Hong, Zheng, Chao-Hui, Li, Ping, Huang, Chang-Ming
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 04-08-2020; Nature Publishing Group
• Subjects: 692/4028/67/1504/1829; 692/53/2422; Aged; Aged, 80 and over; Antigens; Antigens, Tumor-Associated, Carbohydrate - metabolism; Biomarkers; Biomarkers, Tumor - metabolism; Biomedical and Life Sciences; Biomedicine; Cancer Research; Carcinoembryonic antigen; Carcinoembryonic Antigen - metabolism; Drug Resistance; Epidemiology; Female; Gastrectomy; Gastric cancer; Humans; Kaplan-Meier Estimate; Male; Medical prognosis; Middle Aged; Molecular Medicine; Oncology; Patients; Postoperative Period; Preoperative Period; Prognosis; Proportional Hazards Models; Retrospective Studies; Stomach Neoplasms - metabolism; Stomach Neoplasms - mortality; Stomach Neoplasms - surgery; Surgery; Survival; Survival analysis; Tumors
• ISSN: 0007-0920; 1532-1827
• DOI: 10.1038/s41416-020-0901-z

Background
In clinical practice, carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 are the most common markers measured before and after surgery for gastric cancer (GC). However, which pre- or post-operative combined tumour markers (CEA and CA19-9) have more prognostic value remains unclear.
Methods
Consecutive patients undergoing a resection for GC at the Fujian Medical University Union Hospital were included as a discovery database between January 2011 and December 2014. The prognostic impact of pre- and post-operative tumour markers was evaluated using Kaplan–Meier log-rank survival analysis and multivariable Cox regression analysis. The results were then externally validated.
Results
A total of 735 and 400 patients were identified in the discovery cohort and in the validation cohort, respectively. Overall survival rates decreased in a stepwise manner in association with the number of pre- and post-operative positive tumour markers (both
P
 < 0.001). Multivariable analysis revealed that the number of pre-operative positive tumour markers was an independent prognostic factor (
P
 < 0.05). For patients with abnormal pre-operative tumour markers, normalisation of tumour markers after surgery is an independent prognostic protective factor (hazard ratio (HR) = 0.618; 95% confidence interval (CI) = 0.414–0.921), and patients with both positive post-operative tumour markers had double the risk of overall death (HR = 2.338; 95% CI = 1.071–5.101). Similar results were observed in the internal validation and external validation cohorts.
Conclusion
Pre-operative tumour markers have a better discriminatory ability for post-operative survival in GC patients than post-operative tumour markers, and the normalisation of tumour markers after surgery was associated with better survival.